Is psychiatry really medicine? Are the diseases in the DSM really scientific, or just fancy ways to describe self-evident symptoms? The American Psychiatric Association will release the fifth Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, on May 22nd and Gary Greenberg is an ardent critic who believes that most of psychiatry is just hand-waving nonsense. One day we may understand the brain well enough to map some of these disorders onto observable biochemical conditions, but I bet that mapping won't look much like the DSM.

You're a practicing psychotherapist. Can you define "mental illness"?

No. Nobody can.

The DSM lists "disorders." How are disorders different from diseases or illnesses?

The difference between disease and disorder is an attempt on the part of psychiatry to evade the problem they're presented with. Disease is a kind of suffering that's caused by a bio-chemical pathology. Something that can be discovered and targeted with magic bullets. But in many cases our suffering can't be diagnosed that way. Psychiatry was in a crisis in the 1970s over questions like "what is a mental illness?" and "what mental illnesses exist?" One of the first things they did was try to finesse the problem that no mental illness met that definition of a disease. They had yet to identify what the pathogen was, what the disease process consisted of, and how to cure it. So they created a category called "disorder." It's a rhetorical device. It's saying "it's sort of like a disease," but not calling it a disease because all the other doctors will jump down their throats asking, "where's your blood test?" The reason there haven't been any sensible findings tying genetics or any kind of molecular biology to DSM categories is not only that our instruments are crude, but also that the DSM categories aren't real. It's like using a map of the moon to find your way around Russia. ...

It's circular -- thinking that anybody who commits suicide is depressed; anybody who goes into a school with a loaded gun and shoots people must have a mental illness.

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